By Al Devereaux with Zhenya Kurashova Wine
Originally published in Massage & Bodywork magazine, February/March 2002.
Last time we discussed various types of injuries which can plague swimmers. Here, the specific Russian Sports Massage treatment for those injuries will be discussed.
The injuries were grouped into overuse, trauma-related and environmental. We also alluded to the fact that even though these injuries occur in swimming, the same injuries can happen in other sports and everyday activities. Therefore, the treatments presented here would also be appropriate for the same conditions found in the general population and other sports.
The most common daily problems I faced when working with the Williams College swim teams were the overuse conditions created by repetitive motion. The application of massage in the program was not ideal, due to the fact that I would see the swimmers during their workouts. They would get out of the water to receive their massage and then get right back in and continue with the workout. Most of the short 12- to 15-minute sessions would be used to address overuse of the shoulder, specifically the deltoid and rotator cuff musculature. With the healthy athletes, there would be no swelling to worry about, so the primary goal was to increase circulation locally and improve the elasticity of the tissues. For those with overuse injuries, initial palpation would reveal a very “stringy” texture of the deltoid and rotator cuff muscles. After the massage, the “stringy” texture was not as noticeable. The swimmers were also aware of the smoother texture. While the use of massage during the practice was not ideal, I believe it helped prevent injuries by increasing circulation and elasticity.
The sessions always begin with palpation using fingerpads to determine the condition of the tissues you are going to work on. If there is edema, this treatment would be contraindicated.
Application of this treatment is done with both therapist and athlete in the seated position. The therapist faces the athlete’s shoulder at a 45-degree angle and the forearm of the athlete is slightly elevated to produce maximum relaxation of the shoulder muscles (placement of a small flat cushion or a few pillows produces this position). After initial palpation, a few strokes of effleurage are used to start the session. Next, utilize broad friction on the posterior scapula, pectoral and deltoids using heel of the hand friction. When the muscles have started to warm up and relax, fingerpad friction is used across the fibers of the deltoid muscles. Vibration can also be interspersed during the friction. The majority of this treatment – 90 percent – is friction with the remaining 10 percent being split between effleurage and vibration. Length of the treatment is 12 to15 minutes. Remember the massage should be totally painless.
If you are working with basically healthy athletes, this treatment will feel exceptionally good and they will be able to continue with a more productive practice session.
First Degree Strains are characterized as a slight tearing of some fibers. This is usually the result of overuse, rather than a single muscle contraction. In most cases they heal without disability. The treatment described above for overuse would be the treatment of choice for this type of strain, too. There is usually a minimal amount of swelling, if any, so the goal of the treatment would be to increase circulation and improve elasticity. This is accomplished through friction.
Second Degree Strains are more serious and are characterized by significant tearing of muscle or tendon fibers. Some continuity does remain. However, continued use can make the injury worse. With this type of injury, bruising and swelling will occur. There will also be reduced function of the musculotendinous unit. Due to these factors, loss of strength and flexibility will occur.
Our primary goal with massage for a second degree muscular strain is to reduce pain and swelling. This goal is accomplished through the use of effleurage and vibration. In the case of the shoulder, treatment would be done in a seated position and direction of the strokes would be with the lymph flow. Strokes would be done in a continuous pattern, one hand following the other and pressure would be forward (toward the axilla), not downward into the tissues. Treatment would start away from the site of the injury. Injured areas would be touched last. Any other available therapies should also be used. Hydrotherapy and other physical therapy modalities are available in training rooms at colleges. Stretching and strengthening, however, should be avoided until healing has begun. Gentle range of motion should be used as long as there is no pain. Ideally, this initial stage of massage should be done daily, or twice a day, until the swelling is eliminated.
Once the swelling is eliminated, the second phase of treatments can begin. In the second phase, the goal will change since the swelling and pain has been eliminated. The goal in this second phase is to improve elasticity of the tissues. This is done primarily through friction, as in the overuse treatment. We can also add some stretching and gentle strengthening. For toning of the muscles, the massage technique to incorporate is petrissage. Since petrissage stretches and relaxes muscles, it can be used as passive exercise. The breakdown of the stroke percentages would be initially 10 percent effleurage and vibration combined, 10 percent petrissage, and 80 percent friction. As the tissues become healthier, the amount of petrissage can be increased to 40 percent of the treatment by decreasing the amount of friction. These treatments would be done every other day for 12 to 15 minutes and would continue for 15 to 18 treatments. Again I would suggest coordinating with other health professionals to combine the massage treatments with the work of athletic trainers, exercise physiologists, chiropractors, physicians, physical therapists, etc.
An example of treating a second degree strain where there is considerable tearing of the muscle fibers occurred this past swim season. One of the Williams’ distance swimmers tore her pectoralis major muscle doing strength training in January. She was unable to swim using her left arm. She maintained her fitness by biking and kicking. The only thing I could do initially was to attempt to reduce the swelling. I spent the entire 12-minute massage doing continuous effleurage. I attempted to do some vibration, but this was initially too painful. Once the swelling was reduced, three sessions later, I limited the effleurage to the beginning and end of the massage and added friction to soften the scar tissue and make it more pliable. At this point she was able to start training using her arms again. She was still very cautious and in some discomfort while swimming. The entire time span from injury to her starting to swim again was only two weeks. I should also state that she had been seen by a physician for a diagnosis and was also going to the training room for therapy. Palpation revealed an adhesion, or scar tissue, in the lateral pectoralis major muscle. During the course of the friction massage treatment this mass softened so that it was barely noticeable. Light shaking vibration was added to the session, with simultaneous movement of the shoulder joint. Petrissage was also added to help tone and strengthen the muscles. She was still very tentative during her swimming and in meets. Her physician finally gave her the go-ahead and said to just “go for it.” She ended up coming in second to her teammate in the mile at the New England Swimming Championships last February and qualified for the Nationals in both the mile and the 500-freestyle events.
The massage progressed from effleurage only; to friction; to friction, vibration and petrissage. The massage continued throughout the remainder of the season to keep the scar tissue as flexible as possible. It was really amazing to the coach, athlete and myself that an injury this serious was overcome so quickly.
Third Degree Strains, where there is total separation of either the tendon from the bone or separation at the musculotendinous junction or belly of the muscle, is obviously the most serious. In some cases (depending on the muscle involved) surgical intervention may be required. With this type of injury there will be significant swelling and bruising. The primary goal with massage, if surgery is not required, would be to reduce swelling and decrease pain. If surgery is indicated, the primary goal with massage would again be to reduce pain and swelling post-surgery.
I have not personally worked on any swimmers with third degree strains. I have, however, experienced a third degree strain first-hand. I avulsed a hamstring when I hit a dog while cycling. There was loss of function and considerable swelling and bruising. No surgery was performed. Massage was done above the injury to reduce the swelling. The most amazing insight in the power of massage came almost eight months after the accident. I had been having severe cramping in the hamstring whenever I ran. Zhenya (Kurashova Wine) had brought some Russian massage experts to this country for a seminar. One of these people was Anatoly Birukov, professor of sports massage in Moscow. He used me for demonstration and spent no more than 15 minutes of painless massage on my hamstring. I was then able to run not only pain-free, but cramp-free the next day. I was impressed.
For some athletes who experience second and third degree strains, massage will be indicated on an ongoing basis to keep the scar tissue soft.
First Degree Sprains have some minor tearing or stretching of the ligamentous fibers. Usually there will be very little, if any, swelling. Since the ligament is a very avascular tissue, our goal will be to create as much circulation locally as possible. If we can bring more blood into the area, we can promote faster healing. For first degree sprains I start with a few strokes of effleurage and go immediately to friction massage. Russian-type friction massage will promote tremendous local circulation and create heat in the joint. I spend 12 to 15 minutes of friction on and around the joint. The heat in the joint might last for three to five hours after the massage. The typical response from the athlete is that it feels better than the uninjured side. These sessions would ideally be done every day for about 15 to 18 days.
Second Degree Sprains involve significant tearing of many fibers of the ligament and will show swelling and bruising. The primary goal, as in treatment for strains, would be to eliminate the swelling. This is done using massage in the form of continuous effleurage in the direction of the lymph flow. Optimally this would be done for 12 to 15 minutes on a daily or twice daily basis. We cannot proceed to using friction until we eliminate the swelling. If we use Russian-type friction prematurely we will make the situation worse by creating local circulation and thereby increasing swelling. Once the swelling is eliminated, the treatment becomes much the same as treatment for a first degree sprain.
Third Degree Sprains are the worst because they involve total separation of the ligament. Many times these will require surgery. Again there will be significant swelling and bruising. Third degree sprains are many times the result of trauma. This past swim season one of the breaststrokers had a third degree sprain of her anterior cruciate ligament. She was diagnosed by an orthopedic surgeon and debated surgery. The knee was very swollen when I first saw her. My primary goal was to reduce the swelling. I spent 12 minutes of effleurage on the quadriceps group and the swelling was reduced about 80 percent. She and I were both amazed. I told her she should lie down on the floor with her leg up and perform effleurage to herself twice per day. When I saw her again three days later, the swelling was gone. At a follow-up visit, the orthopedic surgeon said as long as she was able to swim pain-free, surgery could be put off until after the season. Once the swelling was gone, I used Russian friction massage to increase local circulation and create heat in the joint. This swimmer completed the season winning events at the New England Championships and placing sixth at the National level. She had her surgery after the season and recovered extremely fast.
Strains and sprains are probably the most common athletic injuries. They are well-suited to the use of massage treatments for rehabilitation. Even first degree strains, if left untreated, can lead to tendinitis, which can be much more difficult to treat. If we can treat athletes on a regular basis, we can stop some of these problems before they become more serious and sometimes prevent them altogether.